The REALL_CART trial, sponsored by Instituto de Investigación Hospital Universitario La Paz, aims to evaluate the feasibility and safety of two distinct CAR T-cell therapies targeting CD19/CD22 and NKG2D in pediatric and young adult patients with relapsed/refractory acute lymphoblastic leukemia (ALL). Given the high unmet medical need in this patient population, particularly for T-ALL, successful outcomes could position these therapies as significant advancements in the treatment landscape. The trial's focus on academic production of CAR T-cells may also provide a cost-effective alternative to commercial therapies, potentially enhancing market access. The competitive landscape includes established CAR T therapies like Kymriah and Yescarta, which primarily target CD19, indicating a need for differentiation through efficacy and safety profiles. Diligence should focus on the trial's recruitment pace, regulatory pathways, and potential for subsequent commercialization or partnerships.